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NPI Code Detail

MEDICARE: MR. RAND CARLETON LUNDMARK CADC II

MEDICARE: MR. RAND CARLETON LUNDMARK CADC II
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorA3651797CA

General Provider Information

NPI Number : 1467965681
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RAND CARLETON LUNDMARK CADC II
Provider Business Mailing Address
First Line : 3517 CAMINO DEL RIO S STE 407
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-4028
Country : US
Telephone Number : 619-955-8905
Fax Number :
Provider Business Practice Location Address
First Line : 3517 CAMINO DEL RIO S STE 407
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-4028
Country : US
Telephone Number : 619-955-8905
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2017
Last Update Date : 11/09/2017

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